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Caplette, Alfred Paul , sr lol LE) I N EW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Alfred Paul Caplette Male Date of Death Age If Veteran of U.S.Armed Forces, 12/14/2023 84 Years War or Dates Vietnam F Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W Manner of Death Undetermined Pending 0 �Natural Cause Accident 1=1Homicide Suicide W C.) Circumstances Investigation W Medical Certifier Name Title CI Asim Chaudry MD Address 100 Park St,Glens Falls, New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 - 585 ElBurial Date Cemetery,Crematory or Facility Name 12/15/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held F Hold Address CO 0 G. Date Point of (i)DTransportation Shipment Q by Common Carrier Destination ODisinterment Date Cemetery Address 0 Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls, New York 12803 Name of Funeral Firm Making Disposition or to Whom F. Remains are Shipped,If Other than Above 5 Address CC W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/15/2023 Registrar of Vital Statistics Megan Nolin(ECectronica(Cy Signed) (signature) District Number 5601 Place City Of Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H `. Z Date of Disposition / —bZa3 Place of Disposition �� �.�,,} ( {-ti p t,A W (address) J W /' N 2 (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Pre ' es ayirlc�a 7 LJCY Z (please pr/nt) /� W Signature 1�9� i Title a DOH-1555(07/18)p 1 of 2 Y A Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#